Process - Physician - Fraser Health Authority

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Medical History:Medical causes of low weight or vomiting ruled out? Yes NoAmenorrhea Yes No LMPHistory of Amenorrhea Yes NoBCP Yes NoPregnant Yes No Week of Pregnancy at Referral:Diabetes: (insulin dependent) Yes NoGI Disorders (i.e. Crohn’s, Celiac Disease): Yes NoAllergies:Other medical conditions:Current Medications (Please list with dosage):Psychiatric History:Please describe any psychiatric symptoms of concern, or current diagnoses:Suicidal Ideation Yes NoDescribe:Self Harm Yes NoDescribe:Substance/Alcohol Abuse Yes NoWhich substances?tobaccomethamphetaminealcoholprescription medscannabisother, please describecocaineTreatment received?:3
Current Treatment for ED /Psychiatric concerns? Yes NoPast Treatment for ED /Psychiatric concerns? Yes NoIf “yes”, please indicate who else is/was providing services for this clientPsychiatristMental <strong>Health</strong> ClinicianPsychologistSt. Paul’s Hospital ED programBC Children’s Hospital ED Program Other: ________________________Lab Work – A current (within 2 months) copy of the following is required:1) ECG2) Full blood biochemistry including all of the below:- CBC and Diff - Serum Phosphate, Magnesium, Zinc- Ferritin, B12 - BUN, Creatinine- Random Blood Sugar - Na, Cl, K, Bicarb- TSH - Serum Protein- ALT, AST, Alk Phos, Bilirubin3) Microscopic Urinalysis to include Specific Gravity.PLEASE REMEMBER TO INCLUDE: (1) all relevant tests (i.e. blood work and ECG),(2) symptoms and frequency,(3) current height and weight,(4) highest and lowest weights, and(5) GP contact info as you will be providing on-goingmedical care for this patient.Please advise your patient that we have a waiting list of at least several months and that she/he will not be put on ourwaiting list until the referral process has been completed. This process includes your completed referral form, blood work,and an ECG. Once on the list, we will invite the patient for an Orientation Session.__________________________________Doctor’s Name & Signature______________________________DateIf you have any questions re completing the referral, please call us at 604-777-8400 and ask for Intake.05/05/094
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SteppedCareLevel 1PSP Mental Health
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Fold back this page before administ
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CBISCOGNITIVE BEHAVIOURAL INTERPERS
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Table of ContentsINTRODUCTION. . .
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IntroductionThe following modules h
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TipsTeachingSelling Strategies• E
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Flow ChartsThis module contains flo
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Patient NeedsTryThe Circle of Depre
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AnxiousSymptomsTryOverwhelmedChaoti
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Assessment ModuleThe Assessment Mod
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5 Energy levela. How would you rate
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15 Phobiasa. Any unrealistic or exc
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21 CAGEHow many drinks might you ha
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DIAGNOSTIC SCREENING WORKSHEET (CON
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Problem List Action PlanACTIVATIONR
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Self-Assessment QuestionnaireName:
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Self-Assessment ProfilePleaser: Hig
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Self-Assessment ProfileOver-Thinker
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Understanding Depression- Frequentl
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Depression: System-Wide CrashDepres
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Activation ModuleThe Activation Mod
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Depression’s Energy BudgetEvery d
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Small GoalsThe concentration, fatig
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Problem SolvingDepression can make
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Chunk the DayStrategies that give p
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Appreciation Exercise“Good for Me
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The Circle of DepressionCognitive-b
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Common Thinking ErrorsThe situation
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THOUGHT CHANGE PROCESS (CONTINUED)T
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Thought StoppingDepression often ma
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Good Guilt / Bad GuiltA world witho
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Setting LimitsMost of us like to be
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Is Anger a Problem for You?Tom arri
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Stress ResponseIntroduction to Rela
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Variation - Box BreathingABDOMINAL
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Body ScanPurpose• Body scan is a
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Stress BustersPurpose• Shorter te
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MindfulnessPurpose• Mindfulness i
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BreathMINDFULNESS MEDITATION (CONTI
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Healthy Habits for SleepingDepressi
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IT’S TRUE: YOU ARE WHAT YOU EAT!
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The Wellness WheelPHYSICALGROWTHSEL
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CBISCognitive Behavioural Interpers
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FLOW CHARTS……………………
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PANIC DISORDER• Anxiety “System
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The Many Faces of AnxietyPanic Diso
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Medical ConsiderationsMost Common M
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Anxiety“System-Wide Explosion”A
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Resources for Self-HelpOnline Resou
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GAD: Self-Assessment QuestionnaireN
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GAD: Self-Assessment ProfileHard Dr
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How Anxiety WorksTHOUGHTSBODYFEELIN
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Panic CircleEvent (public speaking)
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Your Emotional Thermometer• Imagi
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Anxiety EquationAnxiety arises out
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2. When something bad happens, I wo
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Coping CardsAnxious people often ma
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Problem SolvingAnxiety is strengthe
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Example: Kelly begins by making a l
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D.E.S.C. ScriptAssertiveness doesn
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Application forPsychiatric Medicati
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APPENDIX 2: WOMEN’S MENTAL HEALTH
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Pharmacotherapy in the Perinatal Pe
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FAMILY PHYSICIAN GUIDE | ADDRESSING
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Olanzapine (Zyprexa)Tablets, wafers
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Consortium forOrganizationalMentalH
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3. Gather details on current andpre
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Task Two: ADVISE1. Provide meaning
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SUPPORTED SELF‐MANAGEMENT FOR DEP
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TABLE OF CONTENTSIntroduction 1What
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INTRODUCTIONTake a moment now to as
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WHAT IS DEPRESSION?The two most com
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WHAT CAUSES DEPRESSION?People becom
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WHAT CAUSES DEPRESSION?ThoughtsEach
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WHAT CAUSES DEPRESSION?EmotionDepre
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WHAT CAUSES DEPRESSION?ActionDepres
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WHAT CAN YOU DO ABOUT DEPRESSION?MI
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MORE ABOUT MEDICATIONMedication is
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ANTIDEPRESSANT SKILLSIn this sectio
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REACTIVATING YOUR LIFEStep 1: Ident
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REACTIVATING YOUR LIFESmall DutiesE
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REACTIVATING YOUR LIFEStep 2: Choos
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REACTIVATING YOUR LIFEStep 3: Set r
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REACTIVATING YOUR LIFEStep 4: Carry
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THINKING REALISTICALLYNegatively di
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THINKING REALISTICALLYStep 1: Learn
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THINKING REALISTICALLYStep 4: Pract
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SOLVING PROBLEMS EFFECTIVELYStep 1:
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SOLVING PROBLEMS EFFECTIVELYStep 2:
Page 188 and 189: SOLVING PROBLEMS EFFECTIVELYStep 3:
Page 194 and 195: REDUCING THE RISK OF RELAPSEPlan ah
Page 196 and 197: Congratulations! You have now made
Page 198 and 199: SUGGESTED READINGON DEPRESSION AND
Page 200 and 201: DIETThe Canada Food GuideGuidelines
Page 202 and 203: SLEEPStress, anxiety, and depressio
Page 204 and 205: CAFFEINECaffeine stimulates the sym
Page 206 and 207: CHALLENGING DEPRESSIVE THOUGHTSSitu
Page 208 and 209: PROBLEM SOLVINGACTION ADVANTAGES DI
Page 210 and 211: AnxietyDementiaDementiaBipolar155
Page 212 and 213: Practice Support ProgramGeneralized
Page 214 and 215: Montreal Cognitive Assessment(MoCA)
Page 216 and 217: Serial 7s: Administration: The exam
Page 218 and 219: Appendix CNAME OF PATIENTStandardiz
Page 220 and 221: Item 11Scoring WORLD backwards (ins
Page 222 and 223: Appendix CStandardized Mini Mental
Page 224 and 225: SCORING THE MOOD DISORDERQUESTIONNA
Page 226 and 227: FORM 4MENTAL HEALTH ACT[ Sections 2
Page 228 and 229: CommunityMHSU ReferralFormBounceBac
Page 230 and 231: REFERRAL FORMMental Health and Subs
Page 232 and 233: MENTAL HEALTH AFTER HOURSPLEASE LEA
Page 234 and 235: DOCUMENTATION REQUIRED UPON REFERRA
Page 236 and 237: Adult Eating Disorders ProgramRefer
Page 240 and 241: Who Are We?This is a specialized pr
Page 242 and 243: Fraser South Eating Disorders Progr
Page 244 and 245: Medical History:Medical causes of l
Page 246 and 247: Fraser South Eating Disorders Progr
Page 248 and 249: Medical History:Medical causes of l
Page 250 and 251: Fraser East:This program is part of
Page 252 and 253: Fact SheetPanic Disorder GroupDoes
Page 254 and 255: Fact SheetGeneralized Anxiety Group
Page 256 and 257: 4 th Floor Sherbrooke Centre Tel (6
Page 258 and 259: Early Psychosis Intervention Progra
Page 260 and 261: *Additional Resources*For Informati
Page 262 and 263: Mental Healthand Addiction… suppo
Page 264 and 265: Fraser Health Mental Healthand Addi
Page 266 and 267: ADDICTION SERVICESAddiction Service
Page 268 and 269: ADDICTION SERVICESYouth Addictions
Page 270 and 271: ADDICTION SERVICES6. Long-term Resi
Page 272 and 273: MENTAL HEALTH SERVICESMental Health
Page 274 and 275: MENTAL HEALTH SERVICESDelta Mental
Page 276 and 277: MENTAL HEALTH SERVICES4. Community
Page 278 and 279: MENTAL HEALTH SERVICESMinistry of E
Page 280 and 281: MENTAL HEALTH SERVICES7. Residentia
Page 282 and 283: Mental Health & AddictionsHEALTHY L
Page 284 and 285: Client name: ______________________
Page 286 and 287: Client name: ______________________
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Taking Wellness to Heart! Metabolic
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Mental Health and Substance Use Rev
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Collaborative Care Process Map-Epis
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Fax the Special Authority Request t
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o o o o o o o • • • o o o o o
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Process - Physician - Fraser Health Authority

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